THE FIGHT AGAINST MALNUTRITION: POLICIES AND PITFALLS
Dear candidates,
This topic is an evergreen one; however, hunger and malnutrition have become thrust areas since they have direct linkage with poverty and health issues of the country. Moreover, due to various international indexes and reports highlighting extreme poor conditions of malnutrition in India and recent initiatives by the government makes this topic all the more relevant.
The demand of the question is not very broad per say – since it focuses mainly on policies and pitfalls in fight against malnutrition in India. Still you have to provide the broad contours of what malnutrition is, its causes, effects and why it is still persistent in Indian conditions.
Introduction of the essay should catch the attention of the examiner and should also tell about what is going to be there in next few pages, you could define malnutrition, and conclusion of an essay should be such that it should attract the attention of the examiner and leave him/her with a good taste. So, special care should be taken while introducing and concluding an essay. An essay can be introduced in multiple ways, there is no fixed formula or pattern for it. However, some of the popular introductions could include. 1) Some current incident 2) Using an anecdote/story 3) Some quotes 4) Some Facts from reports or commissions
For e.g.: More than 100 children in Bihar in the early morning of a June 2019 showed symptoms of headache, fever, nausea, altered consciousness or unconsciousness and later died which was said to be triggered by consuming Litchi. Later it was found they died of Encephalopathy occurring due to hypo-glycaemia (dangerously low level of glucose) which occurs due to malnourishment. This is just one of the forms of how malnutrition manifests itself.
After this you have to define and describe the main term i.e. malnutrition. The definition should be such that it should cover all aspects of malnutrition. Then explain as to how it manifests itself. As per World Health Organization, malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients. Malnutrition is thus a condition that results from inadequate amount of nutrients in the diet of an individual such that it causes health problems. It may involve calories, protein, carbohydrates, vitamins or minerals.
It is an evil which is omnipresent and affects not only the poor and marginalized but also the affluent, not only the infants and kids but also the elderly. Thus it may manifest itself in different forms for different sections of society. In order to understand its impact, magnitude and global presence, it is essential to understand the manifestation of malnutrition in different forms.
Manifestation of Malnutrition For poor and marginalized sections of society it could appear as underweight, Stunting and Wasting of children, anaemic women, and higher incidence of Infant mortality and Child mortality. For affluent sections of society it may appear as overweight or incidence of diseases like pellagra, mental impairment, and goitre.
In women it may manifest itself as lower weight of women especially during pregnancy, causing complications in pregnancy which leads to threat for both mother and child and is leading cause of maternal mortality. Certain types of malnutrition is associated with conditions when body doesn’t completely accept/ absorb certain kinds of nutrients effectively- especially during morbidity, old age or due to genetic conditions. Combination of different types of malnutrition for e.g. it is possible to be both overweight and micronutrient deficient. Socially marginalized groups like Adivasi may have certain kind malnutrition due to genetic issues or certain kind of deficiencies for e.g. – among the Shaharia tribe – stomach of the kids is filled with water so they do not feel hungry, also vitamins like Niacin and Vitamin C are available in their system but not rest of the vitamins. The topic talks of worldwide perspective of malnutrition and not only Indian point of view. So we have to cater to the demand of the essay. Malnutrition as a worldwide phenomenon
Global Nutrition Report 2018 reveals that malnutrition is a global phenomenon and affects every country in the world.
2 billion people in the world lack key micro nutrients like iron and Vitamin A.
2 billion people are overweight or obese.
It affects both poor and rich countries
While many of the countries have high incidence of both under nutrition as well as overconsumption. Global Alliance for Improved Nutrition reveals that world suffer from various forms of malnutrition and it is the underlying cause of death of 2.6 million children every year.
Malnutrition in India India is a large and diverse country but so is the malnutrition in India. Despite being seventh largest economy of world (nominal; 2018), we are also the capital of malnutrition with more than one third of world’s malnourished children living in India. Former Prime Minister Manmohan Singh has called malnutrition as matter of national shame. India encounters all the manifestation of malnutrition and is notoriously leading the world in most of its forms.
As defined by World Health Organization (WHO)- An Underweight person is defined as a person whose body weight is considered too low for its age to be healthy. And in India 43% of our children under 5years of age are underweight. Stunting is when a person doesn’t grow and achieve the height for its age. India holds almost a third (31%) of the global burden for stunting.
Wasting is when a person doesn’t have requisite weight for its height. India again tops the list with the greatest number of wasted children at 25.5 million. Over 80% of infants and children in India do not get minimum dietary diversity in their meals. Anaemia is a condition of low oxygen carrying capacity of blood. It is more common among pregnant and lactating females. National Family health survey -4 highlights that more than half of Indian women (53%) are anaemic. India also has a high incidence of Infant Mortality Rate (IMR), Under 5 Mortality Rate (U5MR) and Maternal Mortality Rate (MMR). These rates informs about the number of deaths per 1000 live births. As per NFHS-4 India doubled its obese population in last 10 years. A Study published in The New England Journal of Medicine highlighted that with 14.4 million reported cases India has the second highest number of obese children in the world. Before writing about the policies and pitfalls as per the demand question, you have to explain the causes and consequences of the problem. Here you should try to look for the diverse root causes of the problem and it would be best if you could substantiate them with facts and figures from various reports from national or international agencies.
There are multitude of causes associated with rampant malnutrition in most parts of the world UNICEF blamed long term insufficient nutrient intake and frequent infections to be the major cause of malnutrition. Lack of access to nutritious food is the single biggest cause of malnutrition. This might occur due to poverty, unemployment, absence of basic necessities like basic healthcare services, sanitation, and availability of clean drinking water. Lack of awareness due to illiteracy is also a contributing factor for e.g. A 2016 UNICEF-WHO report notes that India, is leading in child deaths every year due to inadequate breastfeeding as most of the mothers are not aware of its essentiality for developing immune system and other benefits, not only during breastfeeding but long after as well. Ignorance of nutritional need of infants and young children results in low birth weight of the new-borns and poor maternal health. “Half do not have enough to eat and the rest of us eat too much”; “Malnutrition can be as common in poverty as in wealth, one for the lack of food, the other for the lack of knowledge of food.”
While the poor can’t afford it, the other haves abuse it. With change in lifestyle the consumption pattern also changes, unhealthy eating habits like increased consumption of trans-fat, carbonated drinks, ill-timing of eating, lack of even minimal physical movement of body throughout the day takes a toll on health.
Hidden Hunger is a type of deficiency caused by eating food that is cheap and filling but deficient in essential vitamins and micronutrients. Hidden hunger is an important root cause of malnutrition among the affluent section. Other lifestyle related diseases like mental stress also contributes to it. Food and Agriculture Organization (FAO) says that the traditional diet grown in local bio diverse regions is disappearing from the plate. This will have both ecological and nutritional consequences. Certain morbid conditions where the nutrient is not properly absorbed by the body like Soil-transmitted helminthiasis (STH) is an infection caused by the intestinal worms, which damage the health of children and adults, specifically women of reproductive age), old age may led to malnutrition. Gender based issues involving patriarchal society especially in case of Asian countries where the females in general are not provided with adequate nutritious food. For e.g. Women in India (eating at last at homes), partiality against the girl child in food distribution at homes, frequent childbirths leads to draining of all the nutrition of the body of women, and early marriages of girls leading to teenage pregnancies.
Social prejudice against the marginalized sections is also responsible for malnutrition. They are provided with limited employment opportunities “dirty jobs” as well as side-lined to live in dark dingy places, away from where the others reside. With ill paid jobs and insanitary habitations they become breeding ground for illness. For e.g. Ghetto formations in many western countries like of African-Americans in USA, Dalits in India. Also landlessness leads to insecurity and marginalization thus contributing to malnutrition.
Geographical and/or Cultural isolation like with the case of Adivasi in India- there is problem of poor reach and quality of essential food and nutrition service. Forest conservation efforts often leads to loss of their land and livelihood. Also half-hearted or no rehabilitation measures are responsible for poor nutritional status of Adivasi.
“There is a sufficiency in the world for man’s need but not for man’s greed.” Deterioration of morality is visible in increasing instances of profiteering, black marketing, hoarding of food grains to fetch higher prices later, while a substantial percentage of people sleep empty stomach. Corruption and commercialization of food are also contributing to malnutrition of the masses in general. At the same time there is large scale wastage of food, in ostentatious functions, hotels. While most of the high end restaurants waste the unused food rather than give it away to the poor.
Social Evils of society like child trafficking, slavery, prostitution also undermines the food and nutritional security of the victims. These people are more prone to various infections like HIV-AIDS and other diseases also.
Governance related issues include lack of availability of safe drinking water, poor sanitation, increasing pollution among others especially in developing countries are reasons for repeatedly falling ill.
External causes like natural calamity, war, drought, famine, floods, conflict, violence, Left wing extremism, terrorism among others also cause long term nutritional insecurities. Sometimes it takes years or even decades to resettle and rehabilitate form these situations. For. E.g. In 2017, drought and armed conflict led to some 22 million children in South Sudan, Yemen, Somalia and north-east Nigeria left hungry, sick, displaced and out of school thus facing imminent risk severe malnutrition. In the Horn of Africa, droughts have exacerbated a large-scale nutrition crisis, leading to hundreds of thousands of children affected by acute malnutrition.
Other problems like environmental conditions, low purchasing power, geographical, agricultural, and cultural including various other factors have contributed effects, resulting in malnutrition.
These causes lead to disastrous effects on not only the economy but also society. Following are some of the consequences of malnutrition.
Biological – “Though quieter than famine, persistent undernutrition kills many more people slowly in the long run than famine do” (Dre’ze and Sen 1998) A malnourished child/person has less chances of survival. A UNICEF study says children with Severe Acute Malnutrition are 9 times more likely to die than well-nourished children. They have impaired immunity and thus are more prone to common childhood diseases like diarrhoea, measles, malaria, pneumonia, Polio. Also experts believe that obesity is the major reason for developing different types of diabetes mellitus and accounts for 80-85 per cent of the risk of developing type-2 diabetes. Low birth weight and prematurity Delayed physical growth and reduced work capacity Delayed mental maturation and Impaired learning ability High maternal mortality and poor lactation performance
“Stunted children have stunted bodies, stunted brains and stunted lives” Brain Drain – A malnourished child suffers from poor brain development leading to impaired learning abilities, poor cognitive skills and physical abilities. It has been seen that a malnourished child enrols late in schools, concentrate less on studies, often falls during Morning Prayer, secures fewer marks and thus perform less well in schools. A report by international non-profit organization Save the Children on Indian children says that a malnourished child scores 7% lower in math’s test, 19% less likely to be able to read simple sentence at the age of eight as compared to her properly nourished counterpart. This inhibits him not only from economic opportunities but also towards leading a meaningful and contently life.
Economic Consequences – Malnourishment leads to deaths, morbidity, mental and frequent physical illness, leading to a restricted or no role towards his/her educational development and
thus socio-economic development of the country and may in fact become a burden to the society. Thus a self-perpetuating vicious cycle of malnourishment and underdevelopment is created. Also government has to spend a certain amount towards eliminating malnourishment as well as the wellbeing of malnourished people through various schemes and policies, this puts an extra burden on the exchequer as it loses on the opportunity cost of investment. As per the estimates of FAO -malnutrition costs $3.5 Trillion per year to the global economy. And the global economic impact of obesity only has been estimated at US$2.0 trillion or 2.8% of global GDP. The report of Save the Children says that considering cognitive and physical impacts on the children and additional medical costs to ill health due to malnutrition can reduce Indian GDP by 2 to 11 %.
Despite having 17% of the world’s population Indian tally of medals in Olympics has been in meagre single digit. Sports are a field which require a balanced combination of both body and mind, which has been an important missing link in Indian scenario due to wide prevalence of malnutrition. How can we expect medals when around half of us are malnourished? Now you have to mention about the policies. What all policies at both international and national level have been formulated and how they tackle the malnutrition. You also have to write an assessment of the policies you mention. Here either you can write policies chronologically or categorize them based on their purpose.
Thus malnutrition has multidimensional causatives which require tackling the approach in similar way Since the earliest times of human history, addressing problem of food and nutrition has been the primary challenge of mankind. From hunting – gathering to settled agriculture to now urbanization this race to satiate hunger is still going on. With still a substantial chunk of population still reeling under hunger and malnutrition a lot needs to be done yet. Internationally many organizations are working specifically to target hunger and malnutrition. For e.g. Food and Agriculture Organization FAO and WHO are committed to end hunger and all forms of malnutrition by 2030 as envisaged by Sustainable Development Goal No. 2. In Indian scenario as per the Directive Principles of State Policy as enshrined in the Constitution of India it is the primary duty of state to raise the level of nutrition of its citizens so that they can utilize their potential and can thereby participate in good governance and contribute to the socio- economic development of the nation. Thus it has always been imperative for the government to control and reduce the incidence and impact of malnutrition. Right from the independence there has been an effort to reduce hunger and malnutrition through various schemes and policies. At the time of independence the country faced threat of famine and acute starvation due to lack of national and regional food security systems and chronic under-nutrition due to low
dietary intake because of lack of purchasing power among the poorer segments of the population. These factors led to wide spread prevalence of infections and ill health in children and adults. Kwashiorkor, Marasmus, Goitre, Beriberi, blindness due to Vitamin- A deficiency and anaemia were major public health problems. Revolutionary initiatives like green revolution and high investment in agriculture have increased the food production to such a level so as to make India self-sufficient. Although a large chunk of population is still underfed. Nobel Laureate Amartya Sen. quipped that Hunger in India is not due to food security but due to poor food distribution. However it is a matter of concern that the population still lacks access to balanced food. Poverty and lack of purchasing power have been identified as two major factors responsible for low dietary intake. The concern over the economic factors resulting in chronic under nutrition led to the use of calorie intake as the basis of estimating poverty and the development of food for work programmes as one of the remedial measures to alleviate this problem of hunger and malnutrition.
The next landmark scheme of government of India is Public Distribution System. It aims at providing food grains at affordable prices to the masses especially the poor section. However despite the subsidised food given through PDS, it has not translated self-sufficiency of food grains at national level into household level food security for the poor. As a reform measure Targeted public distribution system was introduced to provide food grains at subsidized cost to only the people below poverty line. In a parallel effort to reduce chronic under nutrition, food supplementation programmes like Integrated Child Development Scheme were started to cater to identified vulnerable groups such as women and children. ICDS is considered as the flagship scheme for childcare catering to almost all needs of children less than 6 years of age and their mothers with special focus on their nutrition. ICDS was started in 1975 and later it was linked to Anganwadi centres which are to this day nodal agencies for child care. This scheme has been quite successful in providing essential health and nutrition inputs to the women and children along with pre-school education both in rural and urban areas.
Several other food supplementary programs like programs for prevention of iodine deficiency disorders, anaemia and night blindness due to Vitamin A deficiency were initiated to cater to specific deficiencies. Another revolutionary scheme which brought a significant difference in the nutritional outcomes of children has been Mid-Day Meal scheme (MDM). Started in 1995 it was designed by government of India to better the nutritional standing of school age children by supplying free lunches on working days for children in primary and upper primary classes in government, government aided among certain other schools. It is covered under Sarva Shiksha Abhiyan and mandated under National Food Security Act 2013. It is akin to USA’s school lunch program mandated under National School Lunch Act.
Though they were instrumental in providing food security to the targeted sections of society yet these programmes couldn’t achieve significant reduction in incidence of malnutrition, because the programmes tried to provide food supplements to the identified segments of the community and not to identified person/ family of persons suffering under nutrition. Specific micro-nutrient deficiencies as such anaemia (due to deficiency of iron, folic acid), iodine and vitamin A deficiencies persisted because they could neither be tackled through food
supplementation programmes nor by prophylaxis programs since they were not aimed at detection and correction of the deficiency in the individuals. In 21st century, increase in economy and income in hand came with change in lifestyle and alteration of dietary intakes inviting newer problems such as obesity and non-communicable diseases has surfaced. Indira Gandhi Matritva Sahyog Yojana (IGMSY) and Janani Shishu Suraksha Yojana (JSSY) were started in early 2010s and were aimed at nutritional security of pregnant and lactating women along with their child. While JSSY encouraged them for institutional deliveries by providing no expense deliveries along with free diagnosis and medicines, IGMSY provides for partial wage compensation during child birth and child care along with other benefits.
National Food Security Act 2013 is a flagship statute which aims to provide subsidized food grains to approximately two thirds of India’s population. It converts into legal entitlements the provisions of food security programs like MDM, ICDS, and PDS. Though it talks of providing cash transfers, higher nutritional norms for pregnant and lactating women along with children, but it is more cereal centric and doesn’t focus on other nutritional items like pulses, vegetables, fruits, eggs. In contrast Chhattisgarh PDS system is considered to be a model system with use of smart devices in whole value chain to ensure minimum leakage. Chhattisgarh Food Security Act, 2012 does include pulses, grams and iodised salt at subsidized prices.
Village Health and Nutrition Days (VHND) and Mother and Child Protection Card (MCPC) are the joint initiative of the Ministries of Health & Family welfare and the Ministry of Woman and Child for addressing the nutrition concerns in children, pregnant women and lactating mothers. VHND was identified to provide primary care services (health, nutrition and sanitation) at village level under National Rural Health Mission. MCPC is used for record-keeping of services provided during pregnancy and a childhood Tool for families to learn. It empowers families to make decisions for improved health and nutritional status and development of young children on a continual basis
Treatment of children with severe acute malnutrition at special units called the Nutrition Rehabilitation Centres (NRCs), set up at public health facilities. Presently 875 such centres are functional all over the country.
Assessment of these programs Green revolution resulted in increased food production sufficient to meet the needs of growing population; establishment of adequate buffer stocks and PDS have ensured adequate per capita food availability and distribution at the national level. Improvement in per capita income, poverty alleviation programmes including food for work and Employment Assurance Scheme have resulted in improvement of purchasing power and household food availability. Food supplementation programmes were initiated to meet the extra food requirement of vulnerable group’s namely pregnant and lactating mothers and preschool children. Programmes for prevention of iodine deficiency disorders, anaemia and blindness due to Vitamin- A deficiency was initiated by the Dept. of Health and Family Welfare.
There has been substantial reduction in moderate and severe under nutrition in children and some improvement in nutritional status of all segments of population. Many nutrition related diseases like Kwashiorkor, Marasmus, and Night blindness have become rare. However malnutrition continues to be a major problem in pregnant and lactating women leading to high IMR, U5MR and MMR. There is practically zero decline in prevalence or severity of anaemia with National Family Health Survey -4 showing that anaemia incidence among women in India has been brought down by just 2% to 53 % in last 10 years. Newer problems such as obesity in adolescents and adults and increased risk of non-communicable diseases are emerging. To tackle the problems encountered in earlier schemes and approaches and raising the level of nutrition in a comprehensive way on a war footing government has brought National Nutrition Mission.
POSHAN Abhiyan (National Nutrition Mission) is a flagship programme of the Ministry of Women and Child Development (MWCD), which ensures convergence with various programmes i.e., Anganwadi Services, Pradhan Mantri Matru Vandana Yojana (PMMVY), Scheme for Adolescent Girls (SAG) of MWCD Janani Suraksha Yojana (JSY), National Health
Mission (NHM), Swachh-Bharat Mission (SBM), Public Distribution System (PDS), Department Food & Public Distribution, Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) and Ministry of Drinking Water & Sanitation.
Despite a plethora of organizations and schemes at international, national and sub national level to fight malnutrition, substantially high incidence of it still prevails. Several reasons could be assigned to it.
Though the policies and schemes have helped India tackle the issue of food security to a large extent, nutritional security is still a far cry.
Shrinking food basket- Of the 10,000 plant species on earth used for food, the world sources 60 per cent of the plant-based dietary energy from just three crops, wheat, rice and corn. “Intensification of agricultural systems” has led to a substantial reduction in the genetic diversity of domesticated plants and animals in agricultural systems. This prompts farmers to abandon traditional crops and discourage procuring diverse food from the wild. FAO report says that this has led too much focus on the quantity of food grains to attain food security while leaving behind the concern of nutrition.
In most of the cases involving nutritional inputs Responses are reactive, not proactive. Most resources and interventions are reactive; they focus on crisis response rather than preventing problems from progressing that far. Only after there were deaths of tribal children in Odisha in 2016 due to malnutrition did India focused on food and nutritional problems of tribal children in regions of Central India.
In most of the African and even Asian countries decision-makers lack the data to combat malnutrition. There is no single, global system collecting, tracking and processing the many different indicators of malnutrition, which deprives decision-makers of critical insights that could drive more effective solutions.
Also there is absence of any Early Warning System in case of any brewing crisis. Signs of malnutrition may not become apparent until a food crisis erupts. It can be difficult to detect the subtle factors that inevitably produce food shortages and chronic malnutrition before conditions degrade and hunger sets in. For e.g. In India the problem of obesity is crisis in waiting, its incidence has doubled in last decade, but this has not even been taken as a serious challenge to nutritional security of the country.
Faulty agricultural policies – cereal centric agriculture in most of the developing countries with the government policies aiming at promoting cereals only, like easy procurements of the produce through minimum support price in India.
Problem of Outreach – According to the National Family Health Survey estimates, only an estimated 170,000 children receive the treatment they need under these schemes out of a total of 930,000 children who have severe acute malnutrition (SAM) with medical complications. An outreach of 18% for a problem so acute is hardly satisfactory. Absence of convergence of centre, state and district plans of combating malnutrition on the one hand and convergence of various schemes run by different ministries and departments like ICDS, NHM and Swachh Bharat Mission. This leads to either ignoring or certain areas of operation or overlapping jurisdictions of different agencies and schemes. For e.g., Women and Child Development Ministry’s ICDS scheme and program for Infant and Young Child feeding
practices under Ministry of Health and Family Welfare both cater to child and mother having similar implications. Which not only lead to wastage of resources but also loss of economies of scale. One size fits all approach and absence of targeted delivery of nutritional inputs to the neediest sections for e.g. Tribal women in poorest blocks are worst affected with highest levels of malnutrition, but there is no special provisions for such sections. Absence of service delivery models based on evidence of impact of various schemes. Data collection and analysis of data using latest technologies like big data analytics would help us in improvising the existing schemes.
Failure of various government welfare schemes which focuses on employment, poverty alleviation, literacy among others. Success of such schemes acts as a precursor to development of nutritional security. As long as there is widespread prevalence of begging, destitution, homelessness it is nearly impossible to end this menace of malnutrition.
Lack of requisite budget allocation for the nutritional security. The Global Nutrition Report 2018 highlights that the Official Development Assistance to address all forms of malnutrition remains unacceptably low.
Lack of awareness – the awareness component in various government schemes like ICDS were not given due importance. For A report by UNICEF and WHO in collaboration with the Global Breastfeeding Collective highlighted that the rate of exclusive breastfeeding in the first six months of the child birth in India stood at 55% only. It further said that five countries – China, India, Indonesia, Mexico, and Nigeria – account for over 2,36,000 child death every year because of inadequate breastfeeding.
Failure to deal with the root cause- There has been a palliative approach rather than focusing on root causes of the problem of malnutrition. Issues causing vulnerabilities in the society like health contingencies, threat of violence, poverty, illiteracy have not been addressed properly.
As a civil service aspirant you should provide certain solutions, way forward to the problem. These solutions should be pragmatic, you can also take reference from some of the report of commissions, or agencies. It is thus imperative to bring certain reforms which not only involves policy reforms but administrative, behavioural and other systemic reforms.
Bringing convergence in approach, with proper role mapping of schemes to do away with overlapping is essential for smooth functioning of various schemes. POSHAN Abhiyan or National Nutrition Mission promises of such an approach by providing inter-ministerial approach (ICDS, MDM, SABLA, and PDS) to tackling the problem of malnutrition in India. This would require better inter-ministerial coordination as well as appropriate co-ordination between Centre, State and Panchayati Raj institutions. Also NITI Aayog’s 10 point action agenda and Nutrition Strategy envisages a framework under which the four proximate determinants of nutrition — uptake of health services, food, drinking water and sanitation and income and livelihoods — work together to accelerate decline of under-nutrition in India.
Increased Investments in Nutrition- The report, Food for thought: Tackling child malnutrition to unlock potential to boost prosperity, based on a study conducted in four countries—India, Vietnam, Peru and Ethiopia argues that investment in preventing malnutrition in women and children would be the down payment for future prosperity.
A decentralised approach should be promoted with greater flexibility and decision making at the state, district and local levels. This is to enable decentralised planning and local innovation along with accountability for nutrition outcomes. Panchayats should hold at least one Gram Sabha meeting on nutrition and bring back long-forgotten local crops into diet to fight malnutrition. The poor must have adequate entitlements to access food either from the market or through the PDS. Entitlements are better created and preserved through employment programmes such as MGNREGA, or income generation schemes such as DAY-NRLM, since these are less prone to leakages than PDS.
As a part of reform of PDS, making the system of payment of wages in the form of foodgrains more attractive to the workers. This would enhance both food and nutritional security. Focus on keeping the prices of the foodgrains and other vegetables controlled through both economic and administrative actions. Their fluctuations lead to shifting towards non nutritious food items.
Policy intervention include – universalization of ICDS, screening `at risk groups’, growth monitoring, better targeting of food supplements to those suffering from under nutrition, close monitoring of under-nourished persons receiving food supplements; effective inter-sector coordination between health and nutrition workers to ensure early detection and management of health problems associated with or leading to under nutrition.
The culture of extravagance in parties and in general of wasting of food should be discouraged. Statutory provisions of spot fines may be made. USA and France banned supermarkets from destroying unsold food, instead donate to good food banks, charity or fertilizers. Food Sufficiency and Sustainability Initiative – Indian Food Banking n/w promoting collaborative consumption by creating link between surplus and deficit as hunger and food wastage are two sides of the same coin.
Mid-Day Meal Scheme has been a success in lowering the problem of food security. It can now be expanded not only by providing meals twice or thrice but also by addition of more nutritious items in the meal, i.e. eggs, bio-fortified foodgrains.
Decentralization of nutrition schemes – funding should directly reach to panchayats or district level. This would provide flexibility in the scheme as per the local requirements.
Social Audit of all nutrition related schemes so that not only leakage or exclusion inclusion errors can be taken care off but also get feedback on performance of the scheme to make improvements.
Changes in agricultural policies shift from subsiding cereal production to promote crops based on agro-climatic conditions with special focus on crops having high and diverse nutritious value like pulses, legumes, vegetables, fruits. Global Hunger Index report recommends returning to traditional diets comprising locally available, biodiverse food having high nutritious value like vegetables, legumes, fruits and animal sourced foods sourced from kitchen gardens to overcome growing under-nutrition and combating hidden hunger. It says that dietary diversity is the most effective way to prevent hidden hunger. It reiterates the need for protecting local food biodiversity. Empowering the School monitoring Committees by providing them funds and powers for
effective regular monitoring of MDM in schools. Since these committees comprises of parents and members of local bodies, they have a sense of belonging, empowering them would ensure that only hot, freshly cooked nutritious meals reach the students.
Recognition of the problem of obesity and overeating. Statutory provisions like Fat tax in Kerala on unhealthy food items like burger can be extended by other cities as well. Deworming initiatives like distribution of Albendazole tablets to the children should be done more frequently and on larger scale with better outreach, this would help in proper absorption of nutrients by the body. Promoting healthy lifestyle with regular exercises and yoga on regular basis in schools could turn out to be a revolutionary step transforming whole generation of people into healthy and happy and calm beings.
Capacity building of Anganwadi workers and provide them with better prospects and enhanced component of performance related pay. Keeping a benchmark for measuring outcomes and performances like Global Nutrition Targets 2025 which sets the targets based on easily measurable parameters like reduction in anaemia, stunting, and low birthweight.
You can take reference from some of the successful models and other best practices going on across the world, which can be emulated by India.
Best Practices In Uttar Pradesh – MAA committee- mothers included in Anganwadi activities thereby enhancing sense of belongingness and thus effectiveness of nutritional outcomes. It can be emulated by other cities of India.
Certain African countries Senegal, Ghana, Rwanda, Angola, Cameroon, Togo, and Ethiopia have all reduced malnutrition levels significantly over the last 15 years, some by as much as 50 percent. They focused on spotting nutrition problems early on, implementing cutting edge programs, policies needing health, nutrition and agriculture ministries have to work closely together.
In USA every child takes one meal in school, thus even those from affluent families gets a balanced meal in schools, this could be emulated by other countries as well to solve the problem of hidden hunger by providing all the schools with atleast one meal.
Peruvian government’s collaboration with local governments, health professionals and NGOs to focus on improving child nourishment. Here the mothers were incentivized monetarily to conduct regular health and growth check-ups for children in the first three years. This resulted in halving of the chronic malnutrition from 2009 to 2015. Stunting was also halved between 2007 and 2014. Since India has a low outreach of government programs, it will be reduced with a monetary incentive to participate and the problem of knowledge gap is overcome by regular interaction of the parents with the community frontline workers. Human milk banks is a service which collects, screens, processes, and dispenses by prescription human milk donated by nursing mothers. It provides nutritious mother’s milk for orphans and others with no access to it. More than 60 human milk banks around India are trying to ensure access to breast milk for human babies. Feeding new-borns, especially low
birth weight babies with pasteurised breast milk can reduce the risk of infections and boost the immune system. Operation Sulaimani – It’s a free food programme introduced in the city of Kozhikode, India by the district administration and Kerala Hotel and Restaurants, where free plate of Biryani is provided to destitute.
The conclusion should be positive, pragmatic, action oriented, and provide a way forward. Some of the pointers could be.
- Mentioning of constitutional provisions or international covenants like SDGs.
- You may summarize the solutions to the problem that has been provided in your essay.
Malnutrition is an impediment in achieving several goals of society including poverty alleviation, increasing learning outcomes and better health indicators. The prevalence of malnutrition encompassing both under nutrition and overnutrition is an important indicator of the global health. With world population crossing 7 billion mark and poised to cross 8 billion in 2025 there will be rapid rate of growth of infants and young children that require feeding. Making them healthy and responsible citizens of the world who transform into demographic dividend for this planet requires a concerted effort at all levels right from household levels to international levels. Focus areas has to be Africa and South Asia and other developing countries which houses most of the malnourished in the world. With these countries gearing up towards the challenge of hunger and malnutrition free world, many of them have devised their own strategies for e.g. POSHAN Abhiyan for Kuposhan Mukt Bharat in case of India.
With targets set for raising the nutrition level of the world in the form of Sustainable Development Goals’ Global Nutrition Target 2025, all the regions and countries have to strengthen their foundation over which the edifice of nutritional security structure will rest. Preparing broad national frameworks, convergence of multi-stakeholders, learning from past mistakes of self and others and from the best practices across the world, targeting the most vulnerable regions and social groups, addressing the forward and backward linkages associated with nutrition, raising level of community participation, mustering political will and spreading public awareness is the key to eliminate this evil from society root and stem.
